Shock & Weight Based Calculations Flashcards
1
Q
Describe the flow of shock from Local Infection to Death
A
Local infection
Systemic infection (Early Sepsis)
SIRS (Systemic Inflammatory Response Syndrome)
Organ Failure (Severe Sepsis)
Multiple Organ System Failure
(MODS / Septic Shock)
DEATH
2
Q
Wide spread abnormal cellular metabolism
Occurs when…
A
Gas exchange & oxygenation and tissue Perfusion needs are not meet
3
Q
Typs of shock
Severe blood or other fluid loss makes heart unable to pump enough blood to the body
Heart cant pump effectively to pump sufficient blood to meet bodies needs
Blood vessels dilate to an extreme degree
Blood flow to the heart is blocked
Distributive, Cardiogenic, Hypovolemic, Obstructive
A
Hypovolemic
Severe blood or other fluid loss makes heart unable to pump enough blood to the body
Cardiogenic
Heart cant pump effectively to pump sufficient blood to meet bodies needs
Distributive
Blood vessels dilate to an extreme degree
Obstructive
Blood flow to the heart is blocked
4
Q
MAP equation
A
MAP=
3
5
Q
Normal MAP: _____
Minimum MAP for organ perfusion: ______
A
Normal MAP: 70–100 mmHg
Minimum MAP for organ perfusion: ≥ 65 mmHg
MAP Value Indicating Organ Ischemia:
MAP < 60 mmHg → Inadequate organ perfusion, leading to ischemia and organ failure
MAP < 50 mmHg → High risk of cerebral and cardiac ischemia
MAP < 40 mmHg → Possible circulatory collapse
6
Q
Stages of Shoxk
Initial: Not noticeable
Compensatory…..
Progressive…..
Refractory….
A
Compensive: tachycardia/ Increased BP
Progressive: Compensatory Doesn’t Work/ Lower BP, Organ Dysfunction
Refractory: Irreversible Damage
7
Q
Describe common symptoms of Shock
HR
BP
RR
TEMP
URINE OUTPUT
SKIN:
Neurological
Acidosis/ Alkalosis
A
HR: Increased
BP: Decreased
RR: Increased
TEMP: Depends (Hypovolemic = Lower / Septic = Fever)
URINE OUTPUT: Decreased / Dark Urine
Skin: Cool, pale, clammy
Neurological: Confusion/ Lethargy
Acidosis
8
Q
IV fluids and vasopressors to increase / maintain a MAP of …..
A
> 65
9
Q
MAP (Mean Arterial Pressure) is the average pressure in a person’s arteries during one cardiac cycle.
It is an important physiological measurement because it reflects…
A
the perfusion pressure (the pressure that drives blood flow) to the organs and tissues
10
Q
Initial Stage of shock the baseline MAP is decreased by….
Difficult to detect at this stage
A
<10 mmhg
11
Q
Compensatory stage
MAP decreased by….
_____ Mechanism are activated to compensate the change in MAP
Urine output decrease / Tissue Hypoxia
Subjective changes….. (2)
A
10 - 15 mmhg
Kidney & Hormonal
Thirst & Anxiety (Subjective Changes)
12
Q
Progrssive Stage
Sustained decrease in MAP of …..
Vital organs hypoxia
Rapid, low pulse, low BP, pallor, cool, moist skin
LIFE THREATENING EMERGENCY
How long from progressive stage onset must the condition be corrected….
A
> 20 from baseline
< 1 hr
13
Q
Refractory Stage
Too little oxygen reaches tissue cell death & tissue damage
Sequence of cell damage cuased by massive release if toxic metabolies & enzymes…..
A
MODS
14
Q
Hypovolemic Shock CUES
(Increased or Decreased)
pH
PaO²
PaCo²
Lactic acid
Hematocrit & hemoglobin
Potassium
A
Decreased pH
Decreased PaO²
Increased PaCo²
Increased lactic acid
Increased or Decreased hematocrit & hemoglobin
Increased Potassium
15
Q
Hypovolemic Shock
If vasoconstrictor medications (like norepinephrine or epinephrine) Extravasation occurs from IV and necrosis occurs
What is the medication treatment….
A
Phentolamine (Regitine)
16
Q
Causes of this type of shock……
Pump failure
- MI
-Dysrhythmias VT VF - Cardiomyopathy
Treatment (4)
A
Cardiogenic shock
Oxygen delivery CPAP
Decrease Preload
Enhance contractility
- Milrinone
- Dobutamine
Dilation of coronary vessels
- Nitroglycerin
- Nitroprusside
17
Q
To treat Cardiogenic shock related to unable to pump sufficient
Give Oxygen CPAP
Decrease Preload
Give these medications to
Enhance Contractility…
Dilate Coronary Vessels….
A
Enhance Contractility
-Milrinone
- Dobutamine
Dilate Coronary Vessels
-Nitroglycerin
-Nitropruside
18
Q
Cardiac Tamponade
PE
Tension Pneumothorax
Tumors
May cause this type of Shock
A
Obstructive
19
Q
Loss of sympathetic tone
Blood vessel dilation
Vascular leakage
Lead to Distributive Shock
Management
Airway O² / Intubation
Drugs… (2)
A
Epinephrine
Diphenhydramine
20
Q
Causes of this shock are
Neurological
Chemically induced
Anaphylaxis
Capillary leak
Sepsis
A
Distributive
21
Q
1 Mortality in ICU
1 million pts a year
20 billion dollars / 5% Healthcare $$$$
Mortality rate…
Issue…
A
28 - 50%
Sepsis
22
Q
Infection
Normal response
____ Arteries & ____ Veins to increase blood flow.
Neutrophils, Monocytes, Macrophages attack
Local swelling dilates microorganisms & Toxins
A
Dilation of arties & Constriction of veins increase blood flow
23
Q
Sepsis is an over response or a systemic response
Uncontrolled (3)
A
Inflammation
Coagulation
Fibrinolysis
24
Q
The qSOFA score is based on three clinical criteria:
Respiratory Rate ≥ 22 breaths per minute
(Increased respiratory rate may indicate respiratory distress or failure.)
Altered Mental Status
(Any change in mental status, such as confusion, disorientation, or lethargy, can be an early sign of sepsis or organ dysfunction.)
Systolic Blood Pressure ≤ 100 mmHg
(Low blood pressure is an indicator of poor circulation and possible shock, which is common in sepsis.)
What is a Clinical Identiation….
A
2 or more
25
3 criteria for qSOFA
Quick Sequential/ Sepsis Organ Failure Assessment
Score of 2 or more is concerning
Respiratory Rate ≥ 22 breaths per minute
(Increased respiratory rate may indicate respiratory distress or failure.)
Altered Mental Status
(Any change in mental status, such as confusion, disorientation, or lethargy, can be an early sign of sepsis or organ dysfunction.)
Systolic Blood Pressure ≤ 100 mmHg
(Low blood pressure is an indicator of poor circulation and possible shock, which is common in sepsis.)
26
Norepinephrine (Levophed)
Epinephrine (Adrenaline)
Dopamine
Phenylephrine (Neo-Synephrine)
Vasopressin (Pitressin)
Dobutamine
Metaraminol
Angiotensin II (Giapreza)
This type of medication...
This effects...
Vasopressor
Increase BP by construction of blood vessels
27
Septic shock, serum lactate levels can be elevated due to the impaired oxygen delivery to tissues and cells.
Why elevated lacate levels...
Elevated lactate levels are a marker of tissue hypoperfusion and anaerobic metabolism.
When tissues are deprived of sufficient oxygen, they rely on anaerobic metabolism, which produces lactic acid as a byproduct
28
Normal Lactate Levels: Typically, normal serum lactate levels are between......
Mild Elevation: Lactate levels between ______ may indicate early signs of shock or inadequate perfusion, though patients can still be clinically stable.
Severe Elevation: Lactate levels _____ often associated with septic shock and a more severe state of hypoperfusion, indicating significant tissue oxygen deprivation.
Normal 0.5 - 1
Mild Elevation 2-4 mmol/L
Severe Elevation: >4 mmol/L
29
Resuscitation Bundle
Septic Shock
With in .......
Vasopressor (Norepinephrine / Levophed)
Administered how....
Frequent BP monitoring/ GOAL MAP >65
6 hrs
Vasopressor administered via Central Line
30
Septic shock
Reassess volume status & tissue Perfusion
Measure CVP target 8 -12
Central Venous Pressure
Superior vena cava or right atrium, reflecting the blood volume returning to the heart (preload) and the heart's ability to pump it effectively.
What do highs and lows from this indicate....
Measure SvO Target 70%
SvO₂ Percentage of oxygen bound to hemoglobin in the mixed venous blood (typically measured in the pulmonary artery). It reflects the balance between oxygen delivery (DO₂) and oxygen consumption (VO₂).
Use....
High CVP: Suggests fluid overload, right-sided heart failure, or increased intrathoracic pressure.
Low CVP: Indicates hypovolemia (low blood volume), dehydration, or severe vasodilation.
Use of SVO²
SvO₂ is used to monitor oxygen delivery and consumption, especially in critically ill patients. A decrease in SvO₂ often signals worsening shock or inadequate tissue perfusion, while an increase may indicate a mismatch between oxygen delivery and consumption.
31
Procalcitonin is a valuable biomarker in Septic Shock for diagnosing bacterial infection
What is a normal Procalcitonin level....
Normal <0.15 ng/mL
Increased means bacterial infection
32
Additional therapy for Septic Shock.
1. Which respitory condition will call for the use of Mechanical Ventilation...
2. Insulin for BS ....
3. Are DVT prophylaxis used (Lovenox & SCD)
1. ARDS
2. >180
3. Yes
33
Sepsis Quality Indicators
Resuscitation Bundle completed in...
Describe 3 facotrs in the bundle...
3 hrs
1. Serum lactate levels (>2 = lack of oxygen to the cells)
2. Blood culture before Abx.
3. Abx started within 3 hrs of ED admission/ 1 hrs. Inpatient
34
Resuscitation Bundle
How long until Abx are started
ED / Inpatient
ED 3 hrs
Inpatient 1 hr
35
Resuscitation Bundle
With in 6 hrs
Fluids / Vasopressor to maintain map _____
Lactate this level ____
SvO² this level _____
Map >65%
Lactate < 2
SvO2 >65%
36
Management Bundle of Sepsis at 24 hrs
Prevent infection
Control _____
DVT & stress ulcer prophylaxis
Blood Glucose
37
Decreased perfusion and GFR ___ URINE OUTPUT
Potential complications...
Lowered
Obligaría then anuria
ATN / Kidney Failure
38
Early & late Manifestions in Neuromuscular system...
Early: Anxiety/ Restlessness
Late: Lethargy, Weakness, Decreased DTR
39
Cardiovascular
CO....
HR....
Pulse....
Orthostatic hypotension Early
Steadily decreased BP
___ VEINS
Decrease CO
Increased HR
THREADY PULSE
FLAT VEINS
40
PULMONARY
RR...
Paco² & O²
Pallor, Waxy, Cyanosis
Potential ARDS
Increased RR
Increased PaCo² & Decreased O2
41
GI
Bowel Sounds & Motility....
NV
Thirst
Describe BS early & late
Bowel sounds/ Motility Decreased
Early elevated BS & Late Hypoglycemia
42
Integumentary
Pale/ Mottled
Cool
Moist/ Clammy
Dry mouth
Late...
Edema
43
Name Organ
Removes old / bad RBC & WBC
Recycling center for blood cells
Spleen
44
Name Organ
Stores RBC & Platelets
Spleen
45
Name Organ
Produces blood cells
Bone marrow
46
Hemostasis - Describe 4 parts
Vascular Spasm (Vasoconstriction)
Damaged blood vessel constricts to reduce blood flow.
Triggered by nerve reflexes and chemicals like endothelin.
Platelet Plug Formation
Platelets adhere to exposed collagen in the vessel wall.
Activated platelets release signals (ADP, thromboxane A2) to recruit more platelets.
Platelets stick together, forming a temporary plug.
Coagulation (Clot Formation)
Clotting factors activate the coagulation cascade.
Prothrombin → Thrombin, which converts Fibrinogen → Fibrin.
Fibrin forms a stable mesh, reinforcing the platelet plug.
Clot Retraction & Fibrinolysis
Clot contracts to close the wound.
Plasmin breaks down the clot after healing is complete.
47
Men: 4.7 – 6.1 million cells per microliter (μL) of blood
Women: 4.2 – 5.4 million cells/μL
Children: 4.1 – 5.5 million cells/μL
Red Blood Cells (RBCs)
48
Normal range: 4,000 – 11,000 cells/μL
Low WBC (Leukopenia): Below 4,000 cells/μL
High WBC (Leukocytosis): Above 11,000 cells/μL
White Blood Cells (WBCs)
49
Normal range: 150,000 – 450,000 platelets/μL
Platelets (Thrombocytes)
Low Platelets (Thrombocytopenia): Below 150,000 platelets/μL
High Platelets (Thrombocytosis): Above 450,000 platelets/μL
50
Describe integumentary system with Anemia...
Pale/cool skin
Brittle nails
51
MCV (Mean Corpuscular Volume)
Is.....
MCV measures the average size of red blood cells (RBCs) and is used to classify different types of anemia.
52
Normal Range: 80–100 fL (femtoliters) per RBC
Low MCV (<80 fL): ....(Types of Anemia)
High MCV (>100 fL): Macrocytic anemia (e.g., vitamin B12 (Cobalamin) or B9 (Folate) deficiency)
Low <80 Microcytic anemia (e.g., iron deficiency anemia, thalassemia)
High >100 Macrocytic anemia Vitamin B12 or folate deficiency
53
With Sickle cell anemia describe process of Sickle cell crisis...
Describe triggers...
Priority interventions....
Painful episode that occurs when sickle-shaped red blood cells block blood flow, leading to severe pain, organ damage, and complications.
Dehydration, infection, stress, cold temperatures, or low oxygen levels.
Pain
Hydration
Oxygen
Infection
Blood transfusion
54
The following are different types of what disease....
Vaso-occlusive crisis (most common) – Severe pain due to blocked blood flow.
Aplastic crisis – Reduced RBC production, leading to severe anemia.
Sequestration crisis – RBCs trapped in the spleen, causing hypovolemic shock.
Hemolytic crisis – Rapid destruction of RBCs, causing jaundice and anemia.
Types of Sickle Cell Crises:
55
Describe the D5W IV for Sickle Cell crisis..... Rate & Flow
D5W.45 @ 250mL - 4hrs then
125mL /Hr
56
Describe Washed RBC and use....
Give over this time....
Plasma, WNC & Platelets removed to prevent allergic reactions to transfusion.
Give over 2 - 4 hrs
57
1 unit of platelet raises value by...
20,000
58
Is compatibility ABO matching needed for platelets...
No
59
How long of transfusion time to give platelets...
Patient is having chills during transfusion, nurses response....
15 - 30 min
Chills normal reaction. Continue to assess
60
Plasma component of whole blood, frozen within 8 hours of collection to preserve clotting factors. It contains water, electrolytes, albumin, fibrinogen, and coagulation factors (I, II, V, VII, VIII, IX, X, XI, XIII, and protein C & S).
No RBC / WBC
Fresh Frozen Plasma (FFP)
61
Coagulation factor deficiencies (e.g., liver disease, DIC, massive transfusion).
✅ Reversal of Warfarin (Coumadin) toxicity when Vitamin K is too slow.
✅ Massive bleeding or trauma requiring clotting factor replacement.
✅ Thrombotic thrombocytopenic purpura (TTP) – To replace ADAMTS13 enzyme.
✅ Disseminated Intravascular Coagulation (DIC) – To restore clotting factors.
Indication for...
FFP
62
Administration of FFP
✔ Dose: Typically 10–15 mL/kg (around ____ units in adults).
✔ Infusion Rate: Over ______ per unit (must be used within 24 hours after thawing).
✔ Blood Compatibility: ABO matching is ( required/ not required)
Rh matching is not necessary.
4–6
30–60 minutes
ABO required
63
Cryoprecipitate is a component of plasma that is rich in clotting factors
Used for....
Von Willenbrand Syndrome
Bleeding Disorders
64
Albumin is a protein found in human plasma that plays a key role in maintaining oncotic pressure (the osmotic pressure exerted by proteins in the blood)
Transporting substances (like hormones, drugs, and waste) Regulating fluid balance in the body.
Human albumin is commonly used in medical settings as a ______
Normal value...
Plasma volume expander
3.5 - 5
65
The universal donor for red blood cells is ______ , as it has no A, B, or Rh _____, making it compatible with any recipient.
O negative
Antigens
66
The universal recipient for red blood cells is _______ as they can receive blood from any ABO and Rh type
AB positive (AB+)
67
Type A blood has _____ antibodies, so receiving type B blood will cause an immune response
anti-B
68
Type O- blood, with no A, B, or Rh ( Antibodies / Antigens), is the universal donor because it won't provoke an immune reaction
while ____ is the universal recipient because they have no antibodies against A, B, or Rh antigens.
Antigens
AB+
69
Why can't a person with blood type B+ receive blood from a person with blood type A-?
blood type B+ cannot receive blood from a person with blood type A- because they would have antibodies against the A antigen, which would cause a reaction.
70
Transfusion Reaction
Hemolytic
Describe
____ HR
____ RR
____ BP
Describe Febrile reaction...
Increased HR / RR
Decreased BP
Febrile: SAME VS + Chills / Rapid Onset of Sepsis
71
Circulatory Overload from transfusion
Pounding JVD & BP
When to give Lasix...
Between Blood Units
72
Cefepime
Cetfriaxone
Piperacillin / tazobactam
Levofloxacin
Meropenem
Ampicillian / sulbactam
Aztreonam
Antibiotics to treat Sepsis
73
Antibiotics to treat Sepsis (9)
Cefepime
Cetfriaxone
Piperacillin / tazobactam
Levofloxacin
Meropenem
Ampicillian / sulbactam
Aztreonam
74
Type of breathing treatment used for ARDS....
PEP
Positive expiture pressure
75
MOD
Multiple Organ Dysfunction
Key SS....
Disseminated Intravascular Coagulation (DIC) – Uncontrolled clotting and bleeding due to excessive consumption of clotting factors and platelets.
Thrombocytopenia (Low Platelets) – Increased risk of bleeding and impaired clot formation.
Hemolysis (Destruction of Red Blood Cells) – Leads to anemia, hypoxia, and organ damage.
Leukopenia or Leukocytosis – Abnormal white blood cell count, affecting immune response.
Severe Anemia – Decreased red blood cell levels, impairing oxygen delivery to tissues.
Hypoperfusion and Ischemia – Impaired blood flow leading to tissue and organ damage.
76
Indications for HgbA Transfusion in MODS: (3)
Nursing Considerations: Infusion Fast or Slow... How much Fluids.....
Severe anemia (Hgb < 7 g/dL, or symptomatic anemia)
Tissue hypoxia despite oxygen therapy
Hemorrhagic shock or active bleeding
Impaired oxygen delivery contributing to organ failure
NURSING CONSIDERATIONS
Slow infusion / 4L
Baseline & Continuous Monitoring: Vital signs, oxygen saturation, urine output, and signs of transfusion reactions.
✔ Slow Transfusion Rate: Typically 1-2 mL/kg/hr, adjusting based on the patient's status.
✔ Pre-medications if Needed: Antihistamines or acetaminophen for patients with a history of reactions.
✔ Monitor for Signs of TRALI/TACO: Dyspnea, crackles, increased JVP, or decreased SpO₂.
✔ Electrolyte Management: Check calcium, potassium, and acid-base balance post-transfusion.
77
_____ Genetic blood disorder characterized by defective hemoglobin production, leading to chronic anemia.
Mutations in the genes responsible for defective hemoglobin synthesis
The severity depends on whether the person has the minor (carrier), intermedia, or major (severe form requiring lifelong transfusions).
Affects Asians,African, Mediterranean
Thalassemia
78
Risk level for an infant with Thalassemia Major....
Thalassemia Major (Cooley’s Anemia) –
High Risk
Severe life-threatening anemia developing within a few months after birth.
Requires lifelong blood transfusions and iron chelation therapy.
High risk for iron overload, heart failure, infections, and growth retardation.
Maybe dead in 1 year
79
Hemolytic anemia is a condition in which red blood cells (RBCs) are destroyed (hemolysis) faster than they can be produced, leading to anemia and oxygen delivery problems.
It can be inherited (genetic) or acquired (due to external factors like autoimmune disorders.
Name 2 diseases we talked about that fit this description...
Sickle Cell & Thalassemia
80
Vitamin B12 deficiency anemia, also known as _____ anemia when caused by lack of intrinsic factor, occurs when the body does not have enough vitamin B12 (cobalamin) to produce healthy red blood cells.
This leads to macrocytic anemia, neurological complications, and impaired DNA synthesis.
pernicious
81
Causes
Causes of .....
Dietary deficiency (strict vegan/vegetarian diet)
(autoimmune destruction of gastric parietal cells → lack of intrinsic factor)
Gastrointestinal disorders (Crohn’s, celiac, gastric bypass, chronic gastritis)
Medications (metformin, proton pump inhibitors, H2 blockers)
Chronic alcohol use (impairs absorption)
Pernicious anemia (Lack of vitamin B12)
82
_____ anemia is a rare but serious condition where the bone marrow fails to produce enough red blood cells (RBCs), white blood cells (WBCs), and platelets, leading to pancytopenia (low levels of all three blood cell types).
Aplastic
83
Causes of Aplastic Anemia
Idiopathic (Unknown)
Viral
Radation
Auto immune disorder
Medications
84
Type of conditions that require Whole Blood transfusions....
Massive hemorrhage 30 - 40% blood volume / Hypovolemic Shock
Surgery
Injured Soldiers
85
PRB - Packed Red Blood Cells
Restore RBC's Enhance Oxygen, without giving high volume of blood
T or F
T
86
How long to infuse PRBC.....
1 unit increases hemoglobin....
Do you need to check ABO compatibility with PRBC....
Infuse PRBC 2 - 4 hrs
1 unit increases hemoglobin 1 gram
Yes, check compatibility
87
Sepsis Checklist Provider
0 - 3 hrs
Lactate levels
Blood culture
IV ABX
IVF if... SBP < or MAP <65 or Lactate > 4 30cc / kg crystalloid fluids
88
Provider
In first 3 hours when EC Sepsis Order Set Utilized:
Lactate levels
Blood culture
IV ABX
IVF if....
IVF if... SBP < or MAP <65 or Lactate > 4 30cc / kg crystalloid fluids
89
RN responsibilities first 3 hours of EC Sepsis Order Set Utilized
Obtain labs (Lactate & Blood Culture)
Adminster broad spectrum ABX, After Culture has been collected.
Document 2 BP within 1 hr of fluid completion (1 within first 15 minutes)
90
Obtain labs (Lactate & Blood Culture)
Adminster broad spectrum ABX, After Culture has been collected.
Document 2 BP within 1 hr of fluid completion (1 within first 15 minutes)
Which Time Frame for a Sepsis Pt.
Within 1st 3 hours
91
RN responsibilities for hours 3 - 6
Repeat Lactic Acid
Adminster Vasopressor, if ordered
Text Report to RMF floor charge nurse prior to transfer. Cal report to ICU/Progressive. ID pt as ECCS pt.
Provide checklist to floor for continuation of care
92
Main producer of many clotting factors....
Liver
93
Breaksdown RBC. (Organ)
Converted into...
The liver is the primary organ responsible for breaking down hemoglobin.
When red blood cells are recycled, the liver processes the heme portion of hemoglobin into biliverdin, which is then converted to bilirubin. The bilirubin is eventually excreted in bile and helps in the digestion of fats.
94
Hormone primarily produced by the kidneys, although a small amount is also produced in the liver.
It plays a crucial role in regulating the production of red blood cells ________ in the bone marrow.
______ is released in response to low oxygen levels in the blood (hypoxia) and stimulates the bone marrow to increase red blood cell production, helping to improve oxygen delivery to tissues.
(erythropoiesis)
Erythropoietin
95
(Mean Corpuscular Hemoglobin) is a measure of the average amount of hemoglobin in a red blood cell
Describe how Low & High
Low MCH (hypochromia)
Iron deficiency
Anemia
Thalassemia
chronic blood loss, where there is less hemoglobin in each red blood cell.
High MCH (hyperchromia)
macrocytic anemia, where red blood cells are larger than normal, such as in Vitamin B12 or Folate deficiency.
96
When exposed to _____ ,Hbs change RBC cell from round to Sickle shape
Low O²
97
Sickle Cell
Cells clump, block blood flow, cause tissue hypoxia and organ damage.
_____ problem corrected, will return to somewhat normal shape
O²
98
Describe body system with Sickle Cell
Pain
CV
Skin
Abd
MS
CNS
CBC
Pain: Abdomen, back, legs, joints
CV: absent or distant pulses
Skin Cyanosis/ Leg Ulcers
Abd Firm enlarged liver
MS Pain degenerate changes
CNS Stroke / seizures
CBC Increased WBC
99
Are IV opioid appropriate with Sickle Cell...
Yes, First 48 hrs + PCA
Then oral meds
100
Detection of Sepsis Temp how often
Q4hrs
101
Multiple Organ dysfunction
Transfusions
Increase HgbA levels but can cause overload in...
Iron
102
Treatment for Thalassemia (3)
RBC transfusion
Chelation Therapy
Bone Marrow Transplant
103
______ is a medical treatment used to remove heavy metals (such as lead, mercury, arsenic, or iron) from the body. It involves the administration of chelating agents—substances that bind to metal ions—allowing them to be excreted through urine or feces.
Used for which disorder we discussed....
Chelation therapy
Thalassemia
104
Glucose 6 Phosphate Dehydrogenase Deficiency is associated with....
Hemolytic anemia
105
Iron deficiency anemia
1. Take with this vitamin for absorption
2. Stools this color
3. Use Z track for IM Injections
4. SE:
1. Vitamin C
2. Dark green / black
4. Hypotension, flushing, anaphylaxis
106
Uses: Treatment of megoblastic and maxrocytic anemia....
Folic acid
107
Uses: Pernicious anemia & Cyanide Poisoning
Lifelong replacement required
May turn skin / urine red for 2 -5 weeks
Vitamin B12
108
SS of this anemia include
Petechiae/ ecchymosis
Treatment....
Aplastic
Blood transfusion/ antibiotics & antifungal to Replace & Support missing RBC & WBC
109
Hgb transfusion threshold
Acute MI....
Heart disease.....
No heart disease....
Acute MI 9 -10
Heart disease <8.7
No heart disease <7.7
110
Can an A blood type recoeve blood from an AB donor...
No but an AB can recieve blood from an A ( Or anyone else)
111
Are 2 nurses needed to verify a prescription for blood products....
Yes
112
Use proper filtered tubing to transfuse blood.
How long to stay with patient afterwards....
VS q15H 1st hour
Atleast first 30 minutes of infusion
113
Describe what is being replaced / why
RBC
Platelet
Plasma
RBC: RBC lost from trauma / Surgery
Platelet low count <150,000, active bleeding, scheduled invasive procedure
Plasma Replaces blood volume & clotting factors
114
Hemolytic transfusion Reactions happen due to...
ABO / Rh incompatibility
115
Type of Transfusion Reaction
Urticaria, itching, bronchospasm
Rapid onset of sepsis
Febrile
116
Normal hemoglobin / crit levels for men.
Men: 13.8–17.2 g/dL
40 - 52% hemocrit
117
Nomral hemoglobin/ crit levels for women...
Women: 12.1–15.1 g/dL
35 - 47% hemocrit
118
Can A + recieve A - blood?
Can A - recieve A + blood?
A+ can recieve A -
But
A- cannot recieve A+
119
Cardiac Output =
Stroke volume (Ejected with each contractions)
×
HR
120
_______ is a group of diseases that affect the heart muscle, leading to structural and functional abnormalities.
It can result in heart failure, arrhythmias, and sudden cardiac death.
Cardiomyopathy
121
Most common type
Cause: Genetics, viral infections, alcohol, chemotherapy, or idiopathic
Pathophysiology: The heart chambers (especially the left ventricle) enlarge and weaken, reducing pumping ability
Symptoms: Fatigue, shortness of breath, swelling, irregular heartbeat
Dilated Cardiomyopathy
122
Diagnosis of Cardiomyopathy... (4)
Echocardiogram (Echo) – Assesses heart structure and function
Electrocardiogram (ECG) – Detects arrhythmias
MRI or CT scan – Provides detailed imaging
Genetic Testing – Identifies inherited cardiomyopathies
Biopsy (Rarely) – Evaluates muscle tissue
123
Medications
Devices
Life style changes
Surgery
For cardiomyopathy
Medications: Beta-blockers, ACE inhibitors, diuretics, anticoagulants
Implantable Devices: Pacemakers, ICDs (for arrhythmias)
Lifestyle Changes: Low-sodium diet, exercise (as recommended), avoiding alcohol
Surgical Options: Septal myectomy (for HCM), heart transplant (for severe cases)
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The primary site of hematopoiesis, where all blood cells are produced (RBCs, WBCs, platelets).
Red marrow, found in flat bones and the ends of long bones, is responsible for making new blood cells.
The marrow contains stem cells that differentiate into various blood cell types.
Bone Marrow
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Filters the blood, removing damaged or old RBCs and platelets.
Stores blood cells, particularly platelets, and releases them when needed.
Plays a role in immune response by producing WBCs and filtering pathogens from the blood.
Has a role in recycling iron from old RBCs.
Spleen
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Produces important plasma proteins like albumin, clotting factors (fibrinogen, prothrombin), and others that are essential for blood volume, clotting, and immunity.
Stores iron and vitamin B12, important for RBC production.
Breaks down hemoglobin from old RBCs and recycles components like iron.
Produces fibrinogen, which is vital for blood clotting.
Liver
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Involved in the maturation of T-lymphocytes (T-cells), which are essential for the adaptive immune response.
Helps train these immune cells to distinguish between self and foreign invaders, ensuring they don't attack the body's own cells.
Thymus
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Filter lymph fluid and trap pathogens, debris, and cancer cells.
House WBCs, particularly lymphocytes (T-cells, B-cells), which are essential for immune responses.
Serve as sites for immune cell activation and proliferation.
Lymph nodes
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Purpose: Used to evaluate for immune hemolytic anemia. The direct test detects antibodies attached to RBCs, while the indirect test assesses circulating antibodies.
Coombs
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Test for anemia include
CBC
Hemoglobin (Hgb): Low levels indicate anemia.
Hematocrit (Hct): The percentage of blood volume occupied by RBCs, which decreases in anemia.
Red Blood Cell Count (RBC): Helps assess the overall number of RBCs.
Mean Corpuscular Volume (MCV): Measures the average size of RBCs. It helps classify anemia (microcytic, normocytic, or macrocytic).
Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin Concentration (MCHC): Help assess the amount of hemoglobin per RBC.
Iron Studies
Purpose: Helps evaluate the most common causes of anemia (iron deficiency):
Serum Iron: Measures the amount of iron in the blood.
Vitamin B12 and Folate Levels
Purpose: To assess whether deficiencies in these vitamins are causing macrocytic anemia.
Deficiencies can lead to impaired RBC production.
What are Healthy levels of
MCV
MCH
Serum Iron
B12
B9 Folate
(MCV)
Normal Range: 80–100 fL
(MCH)
Normal Range: 27–33 pg (picograms) per RBC
Serum Iron: 60 - 170
B12 200–900 pg/mL
B9 Folate 3.0–17.0 ng
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Pain crises, anemia, stroke, organ damage
Anemia, jaundice, iron overload, bone deformities
Sickle Cell or Thalassemia
Pain crises, anemia, stroke, organ damage (Sickle Cell)
Anemia, jaundice, iron overload, bone deformities (Thalassemia)
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Vaso-occlusive crises, stroke, infections, spleen dysfunction
Iron overload, heart failure, bone deformities
Sickle Cell or Thalassemia
Vaso-occlusive crises, stroke, infections, spleen dysfunction
Sickle Cell
Iron overload, heart failure, bone deformities
Thalassemia
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Pain management, hydroxyurea, blood transfusions, bone marrow transplant
Blood transfusions, iron chelation therapy, bone marrow transplant
Thalassemia or Sickle Cell
Pain management, hydroxyurea, blood transfusions, bone marrow transplant
Sickle Cell
Blood transfusions, iron chelation therapy, bone marrow transplant
Thalassemia
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Distributive Shock: 3 Types
Severe vasodilation causing blood pooling
(Includes Septic, Neurogenic, and Anaphylactic Shock)
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Distributive shock includes Septic Shock, Anaphylaxis, and neurogenic shock.
Describe treatment...
Treat underlying cause (antibiotics for sepsis, epinephrine for anaphylaxis, vasopressors)
